Provider Demographics
NPI:1902826837
Name:ERSTENIUK, EILEEN (CSWR)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:ERSTENIUK
Suffix:
Gender:F
Credentials:CSWR
Other - Prefix:MS
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:HANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1519 NYE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9112
Mailing Address - Country:US
Mailing Address - Phone:315-946-5722
Mailing Address - Fax:315-946-5726
Practice Address - Street 1:1202 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1086
Practice Address - Country:US
Practice Address - Phone:315-331-2030
Practice Address - Fax:315-331-4529
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301071104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD449POtherPREFERRED CARE
NYP010030107OtherBLUE CHOICE & CHILD HLTH
BB8289Medicare ID - Type Unspecified